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Legislative Memo

BILL:

S.3741 (Maziarz) / A.6294 (Wright)

SUBJECT:

Timeframe for application of Medical Treatment Guidelines in Workers’ Compensation

DATE:

May 21, 2012

The Business Council opposes this legislation which prohibits any New York State Medical Treatment Guideline adopted by the Workers’ Compensation Board (the Board) from being retroactively applied.

The adoption of objective medical treatment guidelines for injured workers was a major component of the 2007 workers’ compensation reform legislation jointly supported by business and labor.

Simply put, medical treatment guidelines are standards of care, identifying specific medical treatments that are considered appropriate and effective. Medical treatment guidelines apply the best available evidence gained from the scientific method to clinical decision making. These standards of care assess the strength of evidence of the risks and benefits of treatment (including lack of treatment) and diagnostic tests. They are used throughout the country in the delivery of health care, regardless of which funding stream is reimbursing medical providers for that care (for example, health insurers, workers’ compensation carriers, Medicare, the VA).

New York adopted its medical treatment guidelines in 2009 after a three year process involving input by joint business/labor medical advisory committee and extensive public review and comment by all categories of medical professionals. The Board adopted New York-specific Medical Treatment Guidelines through the rulemaking process; the Board also has a process to update the medical treatment guidelines, as new evidence and peer-reviewed standards of care evolve.

To impose an arbitrary, legislatively-defined timeframe upon which a standard of medical care may be applied, contradicts the very purpose of a standard of care. The NYS MTGs all provide for treatment timeframes, procedures by which medical providers should re-evaluate treatment, active interventions and diagnostic testing procedures. Each MTG stipulates that “passive and palliative interventions are viewed as a means to facilitate progress in an active rehabilitation program with concomitant attainment of objective functional gains.” The regulations provide medical professionals a process to request from the Board a variance from the standard of care provided in the MTGs. Variance requests are no different that similar processes in the realm of health insurance: a medical provider provides the analysis to support a deviation from the established standard of care, and provides the evidence to support his conclusion.

Standards of health care are neither prospective nor retroactive, and such an arbitrary timeframe could have a deleterious impact on a patient as medical and imaging improvements continue to evolve. Medical professionals can substantiate the need for care beyond that which is provided for in the MTG and the Board exercises its authority to review those requests as received.

The Business Council opposes this bill as contrary to evidence-based medicine principles in broad use through the entire system of health care delivery.